Abdominal Pain

Abdominal pain as discussed in this section only refers to that occurring in internal medicine. Those types of abdominal pain seen in surgical and gynecological diseases are discussed elsewhere.

Etiology and Pathogenesis

The abdomen contains the zang-fu organs including the stomach, spleen, liver, gallbladder, large and small intestines, kidneys, bladder, etc., and the Hand and Foot Yangming channels, the Hand and Foot three Yin channels, the Foot Shaoyang channels and the Chong, Ren and Diao channels pass through the abdomen. Therefore, an affection caused by exogenous evils, immoderate diet and drinking, emotional upset and deficiency of yang and qi may lead to stagnation of qi and obstruction or malnutrition of meridians, resulting in abdominal pain.

Abdominal pain may appear as an accompanying symptoms to various diseases. For example, dysentery is characterized by tenesmus and bloody and mucous stools; cholera by vomiting and diarrhea; abdominal mass by a palpable mass; appendicitis by a localized pain and tenderness in the right lower quadrant of the abdomen; hernia by lower abdominal pain radiating to the testes; parasitic infestation by epigastric upset and vomiting; gynecological diseases by disturbances of menstruation, vaginal discharge, pregnancy and childbirth; and so on. These should be distinguished from simple abdominal pain discussed in this section.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between asthenia and sthenia syndromes, and heat and cold syndromes: The pain which is aggravated by pressure and occurs after food intake indicates a sthenia-syndrome, while that relievable by pressure and occurring during hunger shows an asthenia-syndrome. The pain relievable by heat denotes a cold-syndrome, while that relievable by cold signifies a heat-syndrome.

(b) Differentiation between qi and blood disorders: A migratory and distending pain shows the stagnation of qi, and a localized stabbing pain indicates the presence of blood stasis.

(c) Identification of the organ involved: An abdominal pain radiating to the hypochondria may result from a disorder of the liver and gallbladder. A periumbilical and lower abdominal pain indicates the disorder of the spleen, stomach, intestine and bladder, while a pain radiating to the lumbus may relate to the kidneys.

B. Therapeutic principles
Since an obstruction is the basic pathogenesis of pain, opening the obstruction may serve as the general therapeutic principle for abdominal pain. This may be accomplished by various measures according to the different syndromes.

Classification and Treatment

A. Internal stagnation of cold

Manifestations: Abrupt onset of abdominal pain, aversion to cold and desire for warmth, discharge of a large volume of clear urine, loose stool, white, greasy tongue coating and deep and wiry pulse.

Therapeutic principles: Activate qi circulation, expel cold, and regulate the middle jiao.

Prescription: The Modified Pill of Alpiniae Officinarum and Cyperi

Rhizoma Alpiniae Officinarum 10 g
Rhizoma Cyperi 10 g
Caulis Perillae 10 g
Pericarpium Citri Reticulatae 10 g
Radix Linderae 10 g

Remarks: For cases with severs pain around the umbilicus, desire for pressure and warmth, coldness of feet and hands and fading pulse due to deficiency of kidney-yang and obstruction of meridians by cold, add omit Perillae to warm kidney-yang. For cases with cold pain in the abdomen, coldness of extremities and arthralgia, use the Decoction of Aconiti and Cinnamomi to dispel exogenous and endo genous cold.

B. Accumulation of dampness-heat

Manifestations: Abdominal pain and tenderness, chest upset, thirst with desire for drinking, constipation or loose stool, oliguria with reddish urine, spontaneous sweating, yellow and greasy tongue coating and soft-floating and rapid pulse.

Therapeutic principles: Dispel heat, and relieve intestinal stasis by purgation.

Prescription: Powder for Clearing Away Heat in Upper or Middle Jiao

Radix Scutellariae 10 g
Fructus Gardeniae 10 g
Fructus Forsythiae 10 g
Radix et Rhizoma Rhei 6-10 g
Natrii Sulfas Exsiccatus 6 g
Talcum 15 g
Radix Glycyrrhizae 5 g

Remarks: Add Radix Bupleuri, Fructus Toosendan and Radix Curcumae for the cases with hypochondriac pain. Add Fructus Aurantii Immaturus, Fructus Crataegi (fried), Fructus Hordei Germinatus (fried) and fructus Oryzae Germinatus (fried) for those with abdominal distention and dyspepsia.

C. Coldness of zang-organs and deficiency of middle jiao

Manifestations: Intermittent dull pain in the abdomen aggravated by fatigue, desire for warmth and pressure, loose stool, listlessness, shortness of breath, pale tongue with white coating and deep and thready pulse.

Therapeutic principles: Warm the middle jiao, tonify the debility, regulate the interior, and relieve pain.

Prescription: Decoction of Mildly Warming the Middle Jiao

Radix Paeoniae Alba 15 g
Ramulus Cinnamomi 10 g
Radix Glycyrrhizae 5 g
Saccharum Granorum 30 g
Fructus Jujubae 5 pcs
Rhizoma Zingiberis Recens 6 g

Remarks: Add Radix Astragali for cases with fatigue, shortness of breath, spontaneous sweating and susceptibility to catch cold. Add Radix Aconiti Lateralis Praeparata Bolus for Regulating the Middle Jiao for those with abdominal pain, spontaneous sweating, coldness of limbs and deep and slow pulse.

D. Retention of food

Manifestations: Distending pain and tenderness over the epigastrium and abdomen, nausea, acid eructation, defecation, defecation upon abdominal pain or constipation, thick and greasy tongue coating and wiry and smooth pulse.

Therapeutic principles: Relieve dyspepsia.

Prescription: Fructus Aurantii Immaturus Bolus for Relieving Dyspepsia

Fructus Aurantii Immaturus 10 g
Radix et Rhizoma Rhei 10 g
Massa Fermentata Medicinalis 15 g
Radix Scutellariae 10 g
Rhizoma Coptidis 5 g
Rhizoma Alismatis 15 g
Rhizoma Atractylodis Macrocephalae 10 g
Poria 15 g

Remarks: Add Fructus Quisqualis and Fructus Mume for cases with parasitic infestation. Pill for Promoting Digestion may be given in the convalescence stage.

E. Qi stagnation and blood stasis

Manifestations: Migratory distending pain over the abdomen and epigastrium (radiating to the hypochondriac region and relived by eructation or breaking wind but aggravated by anger in the cases with predomination of qi stagnation), severe localized pain in the abdomen, purplish tongue with or without ecchymoses and wiry or thready and uneven pulse in cases with predomination of blood stasis.

Therapeutic principles: Disperse the stagnated liver-qi for cases with predominant qi stagnation, and activate blood circulation and eliminate blood stasis for cases with predominant blood stasis.

Prescription:

1) Radix Bupleuri Powder for Dispersing the Depressed Liver-Qi

Radix Bupleuri 6 g
Pericarpium Citri Reticulatae 6 g
Radix Paeoniae 5 g
Radix Glycyrrhizae Praeparata 3 g
Rhizoma Chuanxiong 5 g
Rhizoma Cyperi 5 g

2) Decoction for Removing Blood Stasis in the Lower Abdomen

Fructus Foeniculi 10 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 6 g
Radix Paeoniae Rubra 15 g
Pollen Typhae 10 g
Faeces Trogopterori 10 g
Myrrha 6 g
Rhizoma Corydalis 10 g
Cortex Cinnamomi 5 g
Rhizoma Zingiberis (dried) 6 g

Remarks: Add Radix Bupleuri and Radix Curcumae for cases with hypochondriac pain. Add Flos Carthami and Herba Lycopi for cases of postoperative pain. Add Herba Centellae, Semen Vaccariae and Bolus for Trauma, or add Yunnan White Medicinal Powder, for cases due to trauma.

Copyright 1995 Hopkins Technology